RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

Author:

Meybohm Patrick1,Kohlhaas Madeline1,Stoppe Christian2,Gruenewald Matthias3,Renner Jochen3,Bein Berthold34,Albrecht Martin3,Cremer Jochen5,Coburn Mark2,Schaelte Gereon2,Boening Andreas6,Niemann Bernd6,Sander Michael78,Roesner Jan910,Kletzin Frank10,Mutlak Haitham1,Westphal Sabine1,Laufenberg‐Feldmann Rita11,Ferner Marion11,Brandes Ivo F.12,Bauer Martin1213,Stehr Sebastian N.1415,Kortgen Andreas14,Wittmann Maria16,Baumgarten Georg1617,Meyer‐Treschan Tanja18,Kienbaum Peter18,Heringlake Matthias19,Schoen Julika1920,Treskatsch Sascha8,Smul Thorsten21,Wolwender Ewa21,Schilling Thomas22,Fuernau Georg23,Bogatsch Holger24,Brosteanu Oana24,Hasenclever Dirk25,Zacharowski Kai1,Stevanovic Ana,Rossaint Rolf,Felzen Marc,Goetzenich Andreas,Moormann Tobias,Chalk Katharina,Knuefermann Pascal,Recht Thomas,Hoeft Andreas,Winterhalter Michael,Iken Sonja,Wiedenbeck Carolin,Schwarzmann Gerhard,Lindau Simone,Zierer Andreas,Fichtlscherer Stephan,Goerlach Gerold,Wollbrueck Matthias,Boening Ursula,Weigand Markus,Strauchmann Julia,Morsbach Kai U.,Paxian Markus,Reinhard Konrad,Scholz Jens,Renner Jochen,Broch Ole,Francksen Helga,Kuhr Bernd,Heinze Hermann,Paarmann Hauke,Sievers Hans‐Hinrich,Klotz Stefan,Hachenberg Thomas,Werner Christian,Mauff Susanne,Alms Angela,Bergt Stefan,Roewer Norbert,

Affiliation:

1. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany

2. Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Aachen, Germany

3. Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig‐Holstein, Germany

4. Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg Hamburg, Germany

5. Department of Cardiovascular Surgery, University Hospital Schleswig‐Holstein, Germany

6. Department of Cardiovascular Surgery, University of Giessen, Germany

7. Department of Anesthesiology and Intensive Care, University of Giessen, Germany

8. Department of Anesthesiology and Intensive Care Medicine, Charité‐Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany

9. Department of Anesthesiology and Intensive Care, Suedstadt Hospital Rostock, Germany

10. Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Rostock, Germany

11. Department of Anesthesiology, Medical Center of Johannes Gutenberg‐University, Mainz, Germany

12. Department of Anesthesiology and Intensive Care Medicine, University Hospital Goettingen, Germany

13. Department of Anesthesiology and Intensive Care, Klinikum Region Hannover, Germany

14. Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany

15. Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany

16. Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany

17. Department of Anesthesiology and Intensive Care Medicine, Johanniter Hospital Bonn, Germany

18. Department of Anesthesiology and Intensive Care Medicine, University Hospital Duesseldorf, Germany

19. Department of Anesthesiology and Intensive Care Medicine, University Luebeck, Germany

20. Department of Anesthesiology and Intensive Care Medicine, Hospital Neuruppin, Germany

21. Department of Anesthesiology, University Hospital Wuerzburg, Germany

22. Department of Anesthesiology, University Hospital Magdeburg, Germany

23. University Heart Luebeck Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Hospital Schleswig‐Holstein, Luebeck, Germany

24. Clinical Trial Centre, University Leipzig, Germany

25. Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany

Abstract

Background Remote ischemic preconditioning ( RIPC ) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham‐ RIPC . Methods and Results In this follow‐up paper, we present 1‐year follow‐up of the composite primary end point and its individual components (all‐cause mortality, myocardial infarction, stroke and acute renal failure), in a sub‐group of patients, intraoperative myocardial dysfunction assessed by transesophageal echocardiography and the incidence of postoperative neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC neither showed any beneficial effect on the 1‐year composite primary end point ( RIPC versus sham‐ RIPC 16.4% versus 16.9%) and its individual components (all‐cause mortality [3.4% versus 2.5%], myocardial infarction [7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0% versus 5.7%]) nor improved intraoperative myocardial dysfunction or incidence of postoperative neurocognitive dysfunction 5 to 7 days (67 [47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%] versus 18 [27.7%] patients), respectively. Conclusions Similar to our main study, RIPC had no effect on intraoperative myocardial dysfunction, neurocognitive function and long‐term outcome in cardiac surgery patients undergoing propofol anesthesia. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 01067703.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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